Folic acid supplementation in end-stage renal disease patients reduces total mortality rate.

Background: Patients with end-stage renal disease (ESRD) are at high risk of cardiovascular disease and elevated serum homocysteine levels. Although folic acid supplementation has been documented to reduce serum homocysteine levels in ESRD patients, most trials of folic acid therapy for reducing cardiovascular diseases in ESRD patients have failed, mainly because of limited patient numbers. Methods: We used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a matchedpair retrospective cohort study to clarify whether folic acid supplementation benefits ESRD patient survival. Patients were divided into a folic acid supplementation group and a control group. All-cause and cardiovascular-related mortality rates between groups were compared. Results: In total, 55,636 stable incident hemodialysis patients were identified from the database. Using a propensity score-matched method and intention-totreat analysis, the survival rate of 17,000 patients with folic acid supplementation was compared with a 1:1 1 Department of Pharmacy, Taipei Medical University Hospital, Taipei Taiwan 2 Clinical Research Center, Taipei Medical University Hospital and School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei Taiwan 3 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei Taiwan 4 Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei Taiwan 5 Evidence-Based Medicine Center, Taipei Medical University Hospital, Taipei Taiwan 6 Department of Family Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei Taiwan 7 Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Taiwan Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei Taiwan 8 Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei Taiwan 9 Graduate Institute of Business Administration, National Taiwan University, Taipei Taiwan Shu-Chen Chien 1,2, Szu-Yuan Li3, Yung-Tai Chen 3,4, Lung-Wen Tsai 5, Tzeng-Ji Chen 6, Tzen-Wen Chen 7,8, Yi-Chun Lin 9 Folic acid supplementation in end-stage renal disease patients reduces total mortality rate ORIgINAL ARTICLE DOI: 10.5301/jn.5000276 matched control group. The baseline demographic data and comorbid disease incidence between the 2 groups were comparable. During the study period, the mortality rate in the matched pair cohort was 35.5% (n = 6,030) over a mean follow-up period of 3.0 years, corresponding to a mortality rate of 12.8/100 patient-years. The all-cause mortality rates were 12.3 and 13.4/100 patient-years in the folic acid group and control group, respectively (p = 0.005). Conclusions: In adult hemodialysis patients, folic acid supplementation improves cardiovascular and allcause mortality rates.